Healthcare Provider Details

I. General information

NPI: 1891728887
Provider Name (Legal Business Name): CORYDON WALTER SIFFRING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 LUDINGTON ST
ESCANABA MI
49829-1300
US

IV. Provider business mailing address

971 DUTTON RD
ROCHESTER HILLS MI
48306-2513
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-5707
  • Fax: 217-757-6573
Mailing address:
  • Phone: 423-863-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD046448L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036144511
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036144511
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberEMC0002596
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD046448L
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD046448L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036144511
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMC-2223
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: